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Stress perfusion magnetic resonance imaging to detect coronary artery lesions in children

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The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Background

Stress perfusion cardiovascular magnetic resonance (CMR) is used widely in adult ischemic heart disease, but data in children is limited. We sought to evaluate feasibility, accuracy and prognostic value of stress CMR in children with suspected coronary artery disease (CAD).

Methods

Stress CMR was reviewed from two pediatric centers over 5 years using a standard pharmacologic protocol. Wall motion abnormalities, perfusion deficits and late enhancement were correlated with coronary angiogram (CAG) when available, and clinical status at 1 year follow-up for major adverse cardiovascular events (MACE; coronary revascularization, non-fatal myocardial infarction and death due to CAD) was recorded.

Results

Sixty-four stress perfusion CMR studies in 48 children (10.9 ± 4.8 years) using adenosine; 59 (92%) and dipyridamole; 5 (8%), were reviewed. Indications were Kawasaki disease (39%), post arterial switch operation (12.5%), post heart transplantation (12.5%), post anomalous coronary artery repair (11%), chest pain (11%), suspected myocarditis or CAD (3%), post coronary revascularization (3%), and others (8%). Twenty-six studies were performed under sedation. Of all studies performed, 66% showed no evidence of ischemia or infarction, 28% had perfusion deficits and 6% had late gadolinium enhancement (LGE) without perfusion deficit. Compared to CAG, the positive predictive value (PPV) of stress CMR was 80% with negative predictive value (NPV) of 88%. At 1 year clinical follow-up, the PPV and NPV of stress CMR to predict MACE were 78 and 98%.

Conclusion

Stress-perfusion CMR, in combination with LGE and wall motion-analysis is a feasible and an accurate method of diagnosing CAD in children. In difficult cases, it also helps guide clinical intervention by complementing conventional CAG with functional information.

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Abbreviations

CMR:

Cardiovascular magnetic resonance

CAD:

Coronary artery disease

PPV:

Positive predictive value

NPV:

Negative predictive value

CAG:

Coronary angiography

MPI:

Myocardial perfusion imaging

PET:

Positron emission tomography

SPECT:

Single photon emission computer tomography

FOV:

Field of view

CI:

Confidence interval

ALCAPA:

Anomalous coronary artery from pulmonary artery

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Acknowledgements

The authors would like to acknowledge Prof. Rungroj Krittayaphong MD, Asst. Prof. Vithaya Chaithiraphan MD, Assoc. Prof. Thananya Boonyasirinant MD, Ass. Prof. Adisak Maneesai MD, Prof. Jarupim Soonswang MD, Prof. Kritvikrom Durongpisitkul MD, Asst. Prof. Prakul Chanthong MD, Asst. Prof. Paweena Chungsomprasong MD, Dr. Supaluck Kanjanauthai MD for their great support in CMR proceeding and a clinical follow up in Siriraj Hospital. We also gratefully thank all technicians of the CMR imaging centers in the Mazankowski Alberta Heart Institute, University of Alberta and Siriraj Hospital, Mahidol University for their great assistance with the images and manuscript preparation.

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Authors and Affiliations

  1. Stollery Children’s Hospital and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada

    Chodchanok Vijarnsorn, Michelle Noga & Edythe B. Tham

  2. Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Chodchanok Vijarnsorn

  3. Variety Children’s Hospital, Winnipeg, Manitoba, Canada

    Daryl Schantz & Dion Pepelassis

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  1. Chodchanok Vijarnsorn
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Correspondence to Chodchanok Vijarnsorn.

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Vijarnsorn, C., Noga, M., Schantz, D. et al. Stress perfusion magnetic resonance imaging to detect coronary artery lesions in children. Int J Cardiovasc Imaging 33, 699–709 (2017). https://doi.org/10.1007/s10554-016-1041-7

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